How do doctors decide which drug to prescribe to treat hypertension?

[mdmjane]

My father has high blood pressure since 3 years ago. There are many types of anti-hypertensive act in differebt ways to lower the BP. But how do docotrs decide which type of anti-hypertensive to give? 

[drvolcanoe]

Mdm Jane...i will go through the CGP (clinical practice guideline) for hypertension & try upload it here someday soon ya. Would hunt for it today if not for the fact that my post-call effect has started taking full-swing effect! Zzzzzz...

[mdmjane]

Thanks Dr. By the way, congrats for the awards you receive!! I think you deserve more awards for your useful posts. I will come back later for your update of this topic.

[niche1]

This is one of the most asked questions regarding HTN. Why does the MD order one drug over the other?
I am a RN and from my perspective, the more accurate a pts history is and the more thorough the physical is, the greater the chance that the appropriate medication is prescribed.

Part of my job is to always act as a pt advocate AND also support the MD. In some cases, certain medications have been prescribed at dosages that are not indicated for the pts presenting symptoms and I have not hesitated to relay that information to the MD.

Having worked on PCU for many years, having a great RN or LPN with a good understanding of the effects of say calcium channel blockers vs beta blockers and why or why not they should be prescribed, can be a God-send to the doctor who is now on hour 18 of no rest and no sleep.

I even had one episode in the ER, in which a Cardiologist bounced some ideas on how to best admin Lasix in a diuresis of a very fragile renal failure pt. I felt honored to assist the MD in coming up with the most appropriate method to administer it. I told him that we could IVP the Lasix in 100cc NS at the rate that he stated that it must be administered.

In the end the pt tolerated the Lasix quite well without any adverse renal complications and the desired effect was obtained.

I am looking forward to seeing the GCP, as I am always interested in the different perspectives that one physician will have over another.

[amanda]

It depends on the severity of the disease.  Age and sex are two of the many factors that they need to consider in choosing hypertensive drugs.  People with hypertension problems has high cholesterol levels and we need to cut it down as much as possible by living a healthy lifestyle, keeping your body fit and disease free.

[mediconweb]

Medicines for treating hypertension can be :
·   Diuretics, which normally form the first line of treatment and have to be given along with potassium supplements as diuretics cause depletion of potassium from the body through the urine.
·   Angiotensin converting enzyme (ACE) inhibitors
·   Angiotensin II receptive blockers (ARBs)
·   Beta blockers
·   Channel blockers

           Drugs combination will also depend on whether there is any accompanying diabetes or any complication of hypertension has developed.
 Secondly, the drugs to be administered will depend on whether, the systolic pressure is raised or the diastolic or both.

      The type of drug to be given and it’s dosage will be determined by the physician after regular blood pressure monitoring while on the therapy. This is because a  particular drug may suit a particular person while it may not suit another. These drugs have their side effects and the patient has to be closely monitored to see whether the drug is controlling the blood pressure as required and whether any side effects to the drugs are developing. Initially, trial and error method may have to be adopted till the doctor is satisfied that he has now put the patient on the best drug or combination of drugs, which suit that patient best.